Exercise Testing and Prescription PET 4551 Study Guide Exam 1 1 Know the modifiable and non modifiable risk factors for heart disease How does exercise improve the risk factors How else can individuals modify their risk factors Know how to determine someone s risk factor for cardiovascular disease What are the emerging risk factors Make sure you know the updated risk factors presented in class this summer I Modifiable Risk Factors for Heart Disease a Hypertension i Systolic blood pressure 140 mmHg and or Diastolic blood pressure 90 mmHg Studies show systolic BP has greater influence on risk If given a case where only one BP is hypertensive go with the number that gives the highest condition to be safe ii Or if the individual is taking anti hypertensive medication even with normal BP ranges they have one risk factor for CVD b Dyslipidemia i Low Density Lipoproteins 130 mg dL ii High Density Lipoproteins 40 mg dL iii Total Cholesterol 200mg dL iv Or if they are on cholesterol lipid lowering medication on test you have to explain why they have a risk factor for dyslipidemia i BMI 30 kg m2 ii Waist girth 102 cm 40 inches for men iii Waist girth 88 cm 35 inches for women d Pre diabetes confirmed by measurements on at least two c Obesity separate occasions i Impaired fasting glucose IFG 1 Fasting plasma glucose 100mg dL but 126 ii Impaired glucose tolerance IGT 1 2 hour values in oral glucose tolerance test OGTT mg dL 140mg dL e Smoking i Current cigarette smoker or those who quit within the ii Exposure to environmental tobacco smoke previous six months f Physically sedentary i Not participating in at least 30 minutes of moderate intensity exercise 40 60 of VO2max at least 3days week for at least 3 months Non modifiable Risk Factors for Heart Disease a Advancing age natural wear and tear on the body and exposure to toxins cause the heart to undergo changes II i Men 45 years ii Women 55 years b Male gender males have an increased risk for heart disease c Family history if any myocardial infarction coronary more testosterone revascularization or sudden death i Males any of these occurrences before the age of 55 years in a father or other male first degree relative sibling ii Females any of these occurrences before the age of 65 years in a mother or other female first degree relative sibling III Improved Risk Factors with Exercise a Reduction in Coronary Artery Disease Risk Factors i Reduced resting systolic and diastolic blood pressures 1 Due to an increase in stroke volume during exercise which is caused by four factors a Contractility increased stimulation of the sympathetic nervous system causes increased calcium influx at the sarcoplasmic reticulum allowing for more myosin actin interactions This is referred to as the Inotropic effect b Preload increased end diastolic volume to deliver more oxygen and hence blood to working muscles and an increased end venous return This is a mechanical feature of the body working against gravity to increase venous return i Frank Starling Mechanism 1 Length tension relationship optimal contractile force when the muscle fibers aren t stretched or relaxed completely 2 Muscular pumps muscles serve as a pump to increase venous return during exercise decreases pressure facilitating an increase in venous return 3 Respiratory pump exhalation 4 Venoconstriction receptors on veins cause veins to constrict shunting blood back to heart c Afterload aortic pressure decreases as resistance to blood flow becomes lower d Treppe effect i Stimulation of the SA node causes the heart rate to increase sending a natural reflex to increase stroke volume Increased serum HDL cholesterol and decreased serum triacylglycerides ii iii Reduced total body fat reduced intra abdominal fat iv Reduced insulin needs improved glucose tolerance 1 Body can burn the glucose in the blood on its own without insulin v Reduced platelet adhesiveness and aggregation IV Other ways to decrease risk factors a Stop smoking i Smoking increases sympathetic nerve activity and catecolamine release 1 Increases BP by 5 10 mmHg 2 Increases HR by 10 15 bpm 3 Increases myocardial contractility 4 Constriction of coronary arteries V VI ii Increases platelet aggregation and oxidation of LDL C How to determine someone s risk factor a Count the risk factors that apply to the individual maximum of 8 total Subtract a risk factor if the individual has an HDL over 60 Emerging Risk Factors a Triacylglycerides b Lipoprotiein A c Lipoprotein remnants d Small LDL particles e HDL subspecies f Apolipoproteins g Total cholesterol to HDL ratio h Homocystein levels i Thrombogenic and hemostatic factors j a Stress increases c reactive protein levels and inflammatory b Type A personality trait associated with hostility and aggression Inflammatory markers high c reactive protein levels VII Other factors responses 2 What are the sources of injury that can happen to the endothelium of the arteries What is Nitric Oxide a Sources of injury that can happen to the endothelium of the arteries a Dyslipidemia b Hypertension walls 1 High LDLs and low HDLS 1 High blood pressure causes increased wear and tear on Immune responses 1 Attack the lining of the walls 1 Indirectly or directly 1 Plastics and environmental hazards c d Smoking e Vasoconstrictor substances f Viral and bacterial infections g Homocysteine h High glucose levels Diabetes i Menopausal women 1 High levels associated with high intake of red meat b Types of dysfunction 1 Associated with decreased levels of estrogen Estrogen has a protective effect on heart disease causing more restriction to blood flow a Vasoconstriction the lumen of the vessels becomes smaller b Growth of fibrous tissues platelet formation c Blood cell and adhesion build up scabs d Thrombosis e Lipid accumulation f Proliferation substances get caught in vessels and block blood flow Occlusions increase with age c Nitric Oxide muscle to allow an increase of blood flow a Strong vasodilator in the body functioning to relax smooth b Blocking the synthesis would stimulate vasoconstriction c The NO levels drop with increasing age Exercise within the elderly population could increase levels of nitric oxide 3 What are the range of values for cholesterol HDLs LDLs triglycerides hematocrit hemoglobin fasting glucose blood pressure BMI waist circumference and hip to waist ratio a Total cholesterol 200 mg dL 5 2 mmol L 200 239 mg dL 5 4 6 2 mmol L Borderline High 240 mg dL 6 2 mmol L Desirable High b LDL s c HDL s 100
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